One of my favorite things as the instructor of the Menopause Transitions course is when participants ask questions. Whether it is something about their own menopause journey or when a patient is struggling with symptoms, it thrills me to provide resources and clarity to help them make informed decisions.

The following are some of the questions that have come up in class or that have been brought to my attention via email after participants are back in the clinic:

Given the many benefits of hormone therapy, should every patient take it during or after perimenopause for the prevention of chronic disease?
This is an excellent question! Based on recommendations from The Menopause Society, hormone therapy is approved for the treatment of vasomotor symptoms, genitourinary symptoms, and the prevention of osteoporosis.

Hormones are often lauded as a benefit for reducing both heart disease and dementia. While it has shown some benefit for heart disease, it is not recommended as a preventative treatment. The same holds true for prevention of neurodegenerative disease. The research on the benefits of hormones in cardiovascular and neurodegenerative disease reductions is often looking a different outcomes.

Each study may use a different type of estrogen. An oral estrogen blend (Premarin), an estradiol patch, and an oral estradiol can all have different effects on the body. You simply cannot extrapolate data from one study to the next if the type of estrogen studied was different. In addition, some research shows no benefit. Based on the current data, hormones are not a slam dunk for the prevention of heart disease and dementia. More studies with the types of hormones that are currently being prescribed are needed before recommending them as prevention.

Hormone therapy is very effective for improving bone density. Osteoporosis is a painless process of bone loss. If a person is not experiencing hot flashes and is concerned about their risk for osteoporosis, they could opt for a DEXA scan and then make an informed decision with their provider regarding hormone therapy.

Is there a dose of estrogen that is more beneficial for treating osteoporosis?
In the 2021 position statement for the management of osteoporosis, the Menopause Society cites a study that shows improved bone density with increased dosage. Oral estradiol doses of .02mg, .05mg, and .075mg after 2 years of treatment correlated with an improvement in lumbar spine bone density of .4%, 2.3%, and 2.7% (Greenwald et.al, 2005). While improvement can be gained from a smaller dose, a higher dose does have more benefit. Once again, informed decision-making with a knowledgeable provider is needed.

What are your go-to resources for all things menopause?
Based on the answers to the two previous questions, I think you can see that The Menopause Society is the gold standard when it comes to all things menopause. The position statements are available on their website and can be accessed for free. This includes guidelines on hormones, non-hormonal treatments, genitourinary syndrome of menopause, and osteoporosis. They also have monthly practice pearls, which include many pertinent topics on current treatments and health concerns for the patient in the transition.

Another great resource is Jen Gutner’s The Vagenda. While complete articles require a subscription to her Substack, she does offer a free email version that shares information about many of the topics flying around in the social media sphere. Her opinions are not always popular, but they are always research-based.

A final resource would be Women Living Better. This website was started by women frustrated with their own perimenopause experience and has resources for patients wanting to know more about options for treatment and symptoms experienced during this time. The founders have also been responsible for some interesting research regarding a survey of 3200 women in perimenopause. This is also available on their website.

Keep in mind that there are many social media influencers with millions of followers who also offer information. They have YouTube channels, Instagram, and websites. Menopause seems to be everywhere! While it is extremely valuable to get the message out there, the conclusions offered are often oversimplified in the attempt to push a quick and easy narrative. If I have learned anything in my knowledge journey, it is that there is no one-size-fits-all answer. Treatment is very individualized based on health status, risk factors, and personal preferences. Nuance is the key when it comes to offering the best outcomes.

If you would like to learn more on this topic, then join me on April 26-27, 2025, in Menopause Transitions and Pelvic Rehabilitation to understand more about the physiological consequences to the body as hormones decline and how to assist our patients in lifestyle habits for successful aging.

References:

1. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause, 2020. 27(9): p. 976-992.
2. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause, 2021. 28(9): p. 973-997.
3. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022. 29(7): p. 767-794.
4. Greenwald, M.W., et al., Oral hormone therapy with 17beta-estradiol and 17beta-estradiol in combination with norethindrone acetate in the prevention of bone loss in early postmenopausal women: dose-dependent effects. Menopause, 2005. 12(6): p. 741-8.
5. The Nonhormone Therapy Position Statement of The North American Menopause Society" Advisory, P., The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 2023. 30(6): p. 573-590.

AUTHOR BIO
Christine Stewart, PT, CMPT

Christine Stewart, PT, CMPT (she/her) graduated from Kansas State University in 1992 and went on to pursue her master’s degree in physical therapy from the University of Kansas Medical Center, graduating in 1994. She began her career specializing in orthopedics and manual therapy, then became interested in women’s health after the birth of her second child.

Christine developed her pelvic health practice in a local hospital with a focus on urinary incontinence and prolapse. She left the practice in 2010 to work at Olathe Health to further focus on pelvic rehabilitation for all genders and obtain her CMPT from the North American Institute of Manual Therapy. She completed Diane Lee’s Integrated Systems Model education series in 2018. Her passion is empowering patients through education and treatment options for the betterment of their health throughout their lifespan. She enjoys speaking to physicians and to community-based organizations on pelvic health physical therapy.